CSA/AZA,in the absence of prednisone,improves linear growth in renal transplanted children

We compared the results of 44 renal transplants in children, of whom 24 were treated with CSA/AZA and 20 with prednisone in combination with AZA and/or CSA. There were no differences in age distribution or mean ages at transplant between the two treatment groups. The CSA/AZA group had a longer follow-up (29 ± 33 vs 17 ± 18 months). At the last follow-up, five children in the CSA/AZA and none in the prednisone group had lost their grafts. Serum creatinine increased in both groups from 0.7 ± 0.1 mg/dl and 0.9 ± 0.1 mg/dl at the end of the first month to 1.1 ± 0.2 mg/dl in the 36th month (CSA/AZA group) (P < 0.0001) and to 1.5 ±0.6 mg/dl in the 18th month (prednisone group) (P < 0.05), respectively. Total cholesterol level was 189 ± 52 mg/dl and 178 ± 60 mg/dl and LDL level was 117 ± 48 mg/dl and 115 ± 51 mg/dl for the prednisone and CSA/AZA groups, respectively. HDL was greater in the CSA/AZA group (50 ± 10 vs 41 ± 10 mg/dl) (P < 0.03), and VLDL was greater in the prednisone group (31 ± 13 vs 22 ± 8 mg/dl) (P < 0.05). Serum triglyceride was greater in the prednisone group (174 ± 93 vs 112 ± 50 mg/dl) (P < 0.03). The standard deviation score for height of the children in the prednisone group did not change (? 2.4 ± 1.4 vs ? 2.1 ± 1.4 SDS), whereas the SDS height score for the CSA/AZA children increased from ? 3.1 ± 1.7 to ? 2.6 ± 1.5, ? 1.9 ± 1.4 and ? 1.7 ± 1.4, at 12, 24 and 36 months, respectively (P < 0.001). CSA/AZA is a good immunosuppressive regime for the first renal transplant in children, but only 75 % tolerated AZA/CSA without same damage to their grafts.     

Correlation between lipid abnormalities and immunosuppressive therapy in renal transplant recipients with stable renal function

Background Hyperlipidemia following successful renal transplantation is a frequent and persistent complication. Several immunosuppressive agents including cyclosporine A (CyA), corticosteroids, and tacrolimus appear to have a significant pathogenetic role. The aim of this study is to investigate the differential effects of different immunosuppressive agents on lipids in renal transplant patients. Methods Two groups of renal transplant recipients, each treated with a different combination of immunosuppressive agents, were studied: Group A (n = 13), cyclosporine A, mycophenolate mofetil (MMF), steroids, and basiliximab; Group B (n = 13), tacrolimus, MMF, steroids, and daclizumab). Plasma lipids [cholesterol (CHOL), low-density lipoprotein (LDL)-CHOL, high-density lipoprotein (HDL)-CHOL, and triglycerides (TG)] were examined before transplantation and 1 and 6 months posttransplantation. Results The patients treated with cyclosporine A-MMF showed a significant increase in mean cholesterol and mean LDL-cholesterol values at the 1-month posttransplantation follow-up compared with pretransplant levels (CHOL: 208.9 ± 47.4 vs. 268.7 ± 42.2 mg/dl, P = 0.004; LDL: 118.4 ± 49.9 vs. 198.7 ± 40.7 mg/dl, P = 0.002; pretransplant vs. 1 month, respectively). At 6 months, LDL-cholesterol levels were significantly elevated compared with pretransplant levels (LDL: 118.4 ± 49.9 vs. 148.3 ± 48.5 mg/dl, P = 0.034), whereas there was no significant change in the cholesterol level during the same period. In cyclosporine A-MMF-treated patients, plasma triglyceride levels were reduced at the 1- and 6-month follow-up (TG: 293.9 ± 59.2 vs. 182.9 ± 48.7 mg/dl, P = 0.03; 293.9 ± 59.2 vs. 178.6 ± 74.2 mg/dl, P = 0.023; pretransplant vs. 1 and 6 months, respectively). Patients receiving combined therapy with tacrolimus-MMF showed no significant changes in LDL-CHOL levels during the trial. Cholesterol levels at 6 months posttransplantation were significantly lower than the pretransplant measurements (CHOL: 182.9 ± 44.4 vs. 162.3 ± 37.2 mg/dl, P = 0.024; pretransplant vs. 6 months ). A significant reduction in triglyceride level was documented at the 1-month follow-up followed by a subsequent decrease within 6 months (TG: 228.5 ± 61.6 vs. 147.6 ± 51.5 mg/dl, P = 0.005; TG: 228.5 ± 61.6 vs. 130.4 ± 54.7 mg/dl, P = 0.011; pretransplant vs. 1 and 6 months, respectively). Conclusions In posttransplant patients with stable renal function cyclosporine therapy is associated with increased cholesterol and LDL-cholesterol levels. Hyperlipidemia is less pronounced in patients given tacrolimus. Tacrolimus appears to an immunosuppressant agent with fewer and less severe adverse effects on lipid metabolism.     

Combined treatment of hypercholesterolemia of renal transplant allograft recipients with fluvastatin and gemfibrozil

Abstract The aim of this study was to investigate the safety and efficacy of combined treatment with fluvastatin (F) and gemfibrozil (G) in hypercholesterolemic renal transplant recipients (RTR). Ten hypercholesterolemic (total cholesterol [TC] > 220 mg/dl) RTR (7 men) with mean age 44 years (range 25‐56 years) who remained hypercholesterolemic after 3 months of treatment (period A) with fluvastatin (40 mg/d) continued taking the same dose of F plus G (600 mg/dl) for another 3‐month period (B). Serum total cholesterol, high density lipoprotein cholesterol (HDL‐C), LDL cholesterol (LDL‐C), triglyceride, serum creatinine (creatinine phosphokinase (CPK), serum glutamic‐oxaloacetic transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) were measured before treatment and at the end of periods A and B. Mean TC levels were 360.30 ± 62.42 mg/dl, 324.10 ± 100.53 mg/dl, 270.80 ± 67.77 mg/dl; mean LDL‐C levels were 259.33 ± 71.43 mg/dl, 219.60 ± 81.31 mg/dl, 189.70 ± 65.51 mg/dl; mean HDL‐C levels were 37.10 ± 11.68 mg/dl, 39.80 ± 13.21 mg/dl, 41.00 ± 12.94 mg/dl; mean triglyceride levels were 354.60 ± 183.29 mg/dl, 349.30 ± 242.94 mg/dl, 207.00 ± 85.35 mg/dl before treatment and at the end of periods A and B, respectively. There was a statistically significant fall of serum TC (P = 0.002), LDL‐C (P = 0.016), and triglyceride (P = 0.029) levels at the end of periods A and B. Kidney and liver function did not change. F and G combined treatment is safe and useful in patients who do not respond satisfactorily to monotherapy with F. Gemfibrozil augments the effect of F on TC, LDL‐C, and triglyceride levels.     

Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome

A total of 30 patients (ten female/20 male), 9 years to 22 years old (mean age 17.3 years) and 30 healthy teenage controls (mean age 16.4 years) were included in our study. The patients had steroid-sensitive idiopathic nephrotic syndrome (INS) and had completed steroid therapy 4 years to 15 years ago. Height and weight, body mass index (BMI), body composition, and intima-media thickness (IMT) were determined, as were levels of total cholesterol (TCh), low-density lipoprotein cholesterol (LDL-Ch), high-density lipoprotein cholesterol (HDL-Ch), triacylglycerols (TAGs), homocysteine (HCY), and high-sensitivity C-reactive protein (hsCRP). We did not observe any differences between the study and control groups in IMT (0.47 ± 0.1 vs 0.46 ± 0.1 mm) and body composition (fat tissue and water content). Differences in HDL-Ch and hsCRP levels between groups were not significant. In the study group we found significantly higher TCh levels (187.6 ± 57.2 mg/dl vs 158.8 ± 25.7 mg/dl; P = 0.012), LDL-Ch (115.9 ± 63.7 mg/dl vs 79.4 ± 25.4 mg/dl; P = 0.005), HCY (12.3 ± 7.7 μmol/l vs 7.6 ± 1.6 μmol/dl; P < 0.001), apolipoprotein B (ApoB) (113.6 ± 30.0 mg/dl vs 78.7 ± 13.6 mg/dl; P < 0.001) and ApoA1 (203.5 ± 50.8 mg/dl vs 156.5 ± 12.4 mg/dl; P < 0.001) levels. Multi-factor analysis of the influence of independent factors (number of recurrences, duration of remission, age, gender, and BMI) on the parameters under investigation indicated a positive correlation between IMT and the number of recurrences. Conclusions: 1. Patients treated for idiopathic nephrotic syndrome in the past should undergo regular laboratory tests of atherosclerosis risk factors, including not only cholesterol and its fractions, but also ApoA1, ApoB and HCY. 2. It is necessary to continue systematic check-ups of the intima-media thickness of the carotid arteries among young patients with anamnesis of INS, especially among patients who suffered from numerous relapses of this disease.     

The effect of fluvastatin of hyperlipidemia in renal transplant recipients: A prospective,placebo- controlled study

Posttransplant hyperlipidemia is a common complication which may affect long term cardiovascular mortality. In this prospective, placebo-controlled study, 19 renal transplant recipients (11 male 8 female, mean age 31.2 ± 8.4 years) with good allograft function (serum creatinine <2 mg/dl) more than 6 months after transplantation were included. All the patients had hyperlipidemia (serum cholesterol >230 mg/dl and/or LDL-cholesterol >130 mg/dl) despite dietary interventions. The patients were treated with a triple immunosuppressive regimen. After a 8-week period of placebo plus diet regimen, the patients were put on fluvastatin plus diet for another 8 weeks. The patients were followed for its effect on lipid parameters and side effects. After convertion to fluvastatin, serum cholesterol (263.0 ± 31.6 vs 223.2 ± 31.6 mg/dl, p = 0.001), LDL-cholesterol (174.4 ± 28.3 vs 136.4 ± 28.5 mg/dl, p = 0.002), Apolipoprotein (Apo) A₁ (131.1 ± 16.9 vs 114.7 ± 18.4 mg/dl, p = 0.001) and Apo B (109.0 ± 29.8 vs 97.3 ± 31.5 mg/dl, p = 0.02) levels decreased significantly. Serum levels of triglycerides, VLDL-cholesterol and HDL-cholesterol levels did not vary under fluvastatin. Serum lipoprotein (a) levels were also unchanged during the whole study period (24.9 ± 19.4 vs 23.1 ± 19.8 mg/dl, p > 0.05). We concluded that fluvastatin effectively decreased atherogenic lipoproteins such as serum cholesterol, LDL-cholesterol, Apo B in posttransplant hyperlipidemia, however fluvastatin had no effect on another independent risk factor of atherogenesis, serum lipoprotein (a) levels. This revised version was published online in June 2006 with corrections to the Cover Date.     

Impact of Restrictive (Sleeve Gastrectomy) vs Hybrid Bariatric Surgery (Roux-en-Y Gastric Bypass) on Lipid Profile

Background

Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile, with the results being contradictory. The effect of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on lipid profile was compared.

Methods

A nonrandomized prospective cohort study was conducted on severely obese patients undergoing bariatric surgery. Indication for the type of surgical procedure was based on clinical criteria. Patients on lipid-lowering drugs and those that could not be matched for age, sex, and body mass index were excluded. Finally, 51 patients who underwent LSG and 51 undergoing LRYGB completed this study.

Results

During the first year post-surgery, no differences in percentage of excess weight loss and triglyceride reduction were found between groups. After LRYGR, low-density lipoprotein (LDL) cholesterol concentrations fell significantly (125.9?±?29.3 to 100.3?±?26.4?mg/dl, p?p?=?0.220). High-density lipoprotein (HDL) cholesterol increase was significantly greater after LSG (15.4?±?13.1?mg/dl) compared with LRYGB (9.4?±?14.0?mg/dl, p?=?0.032). Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB. A greater increase in HDL cholesterol was associated with LSG, older age, and baseline HDL cholesterol.

Conclusions

LRYGB produces an overall improvement in lipid profile, with a clear benefit in all lipid fractions. Although LSG does not alter LDL cholesterol levels, its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques.     

Changes in Blood Lipid Levels following Silastic Ring Vertical Gastroplasty

Background The purpose of this study was to evaluate the effect of the Silastic Ring Vertical Gastroplasty (SRVG) operation on blood lipid levels in obese men and women during the first year following surgery. Methods 25 patients (11 men and 14 women) age 17–50 (mean 33 years) who suffered from morbid obesity (BMI > 40, range 45.9 ± 4.7 kg/m²) underwent SRVG. Blood samples were collected before operation and 3, 6 and 12 months following surgery and tested for: triglycerides, total cholesterol, HDL-C, LDL-C, VLDLC, and Lp(a). Results Both men and women lost weight significantly. Mean BMI decreased from 48.0 to 32.5 kg/m² in men and from 44.3 to 29.0 kg/m² in women (P < 0.01). Blood lipid levels 1 year following surgery demonstrated the following changes: In women, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 160.7 mg/dL to 67.7 mg/dL (P < 0.01), from 220 mg/dL to 189 mg/dL, from 138.3 mg/dL to 111 mg/dL, from 17 mg/dL to 12 mg/dL, and from 77.5 mg/dL to 18.5 mg/dL (P < 0.01), respectively, and HDL increased from 45 mg/dL to 50.5 mg/dL. In men, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 246 mg/dL to 140 mg/dL (P < 0.01), from 206 mg/dL to 170 mg/dL (P < 0.01), from 134 mg/dL to 112 mg/dL (P < 0.05), from 25 mg/dL to 15 mg/dL (P < 0.01), and from 30.3 mg/dL to 11.6 mg/dL (P < 0.01), respectively, and HDL increased from 31.3 mg/dL to 37.4 mg/dL (P < 0.05). Conclusion SRVG improved blood lipid profile in obese patients during the first year following surgery. Reduction in cholesterol and its fractions reaches statistical significance only in men.     

Is splenectomy a dyslipidemic intervention? Experimental response of serum lipids to different diets and operations

Spleen removal may be recommended during organ transplantation in ABO‐incompatible recipients as well as for hypoperfusion of the grafted liver, besides conventional surgical indications, but elevation of serum lipids has been observed in certain contexts. Aiming to analyze the influence of two dietary regimens on lipid profile, an experimental study was conducted. Methods: Male Wistar rats (n = 86, 333.0 ± 32.2 g) were divided in four groups: group 1: controls; group 2: sham operation; group 3: total splenectomy; group 4: subtotal splenectomy with upper pole preservation; subgroups A (cholesterol reducing chow) and B (cholesterol‐rich mixture) were established, and diet was given during 90 days. Total cholesterol (Tchol), high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), very‐low‐density lipoprotein (VLDL), and triglycerides were documented. Results: After total splenectomy, hyperlipidemia ensued with cholesterol‐reducing chow. Tchol, LDL, VLDL, triglycerides, and HDL changed from 56.4 ± 9.2, 24.6 ± 4.7, 9.7 ± 2.2, 48.6 ± 11.1, and 22.4 ± 4.3 mg/dL to 66.9 ± 11.4, 29.9 ± 5.9, 10.9 ± 2.3, 54.3 ± 11.4, and 26.1 ± 5.1 mg/dL, respectively. Upper pole preservation inhibited abnormalities of Tchol, HDL, VLDL, and triglycerides, and LDL decreased (23.6 ± 4.9 vs. 22.1 ± 5.1, P = 0.002). Higher concentrations were triggered by splenectomy and cholesterol‐enriched diet (Tchol 59.4 ± 10.1 vs. 83.9 ± 14.3 mg/dL, P = 0.000), and upper‐pole preservation diminished without abolishing hyperlipidemia (Tchol 55.9 ± 10.0 vs. 62.3 ± 7.8, P = 0.002). Conclusions: After splenectomy, hyperlipidemia occurred with both diets. Preservation of the upper pole tended to correct dyslipidemia in modality A and to attenuate it in subgroup B. © 2008 Wiley‐Liss, Inc. Microsurgery, 2009.     

Behavior of insulin sensitivity and its relation to leptin and tumor necrosis factor-alpha in obese women undergoing liposuction: 6-month follow-up

Background: Metabolic syndrome is a group of pathological processes which involve insulin resistance, a biochemical and molecular disorder. Obesity appears to be the most frequent clinical component in metabolic syndrome. Subcutaneous fat, independent from visceral fat, is still controversial as a marker of the pathophysiology of insulin resistance. Methods: An open parallel-group clinical trial was performed of 12 women (age 30–40 years), with BMI from 30–33 kg/m² and fasting glucose ≤110 mg/dl. 6 women were included in the “liposuction plus diet” group, and 6 were included in the “diet-only” group. Metabolic profile, including insulin tolerance test (ITT), leptin and tumor necrosis factor alpha (TNFα), was performed at baseline, 1 and 6 months in both groups. Subcutaneous and visceral fat was quantified with spiral tomography at baseline and after 6 months. Friedman and Wilcoxon test were used for intra-group differences, Mann-Whitney U for differences between groups, and Spearman test for correlation, with significance set atP<0.05. Results: No difference existed between groups regarding clinical characteristics and metabolic profile. In the liposuction group, the increase in insulin sensitivity was (3.8±0.86, 3.1±0.85, 4.5±1.02 %/min,P=0.08. Insulin sensitivity did not correlate with subcutaneous fat, leptin, or TNFα. Leptin diminished at 1 month (52.7±6.04 vs 31.6±11.9),P=0.028, and correlated with the subcutaneous fat (r=0.957). In the diet-only group, TNFα diminished at 6 months,P=0.046. Conclusion: Subcutaneous abdominal fat correlates with leptin; nevertheless, it is a weak marker for TNFα and insulin sensitivity.     

Dietary cholesterol and oxidised cholesterol: effects on sperm characteristics,antioxidant status and hormonal profile in rats

Present study was designed to compare the potential effects of high serum levels of LDL and oxidised LDL (OxLDL) on spermatogenesis parameters in male Wistar rats. Animals were allocated into three groups and were fed for 14 weeks with normal, cholesterol‐rich and oxidised cholesterol‐rich diets. Blood lipid profile, sex hormones level, as well as sex organs weight were evaluated. The sex organs weight in oxidised cholesterol‐fed group was significantly reduced (P < 0.05). Spermatozoa count in the group with high serum concentration of OxLDL (64 ± 4.2 × 10⁶) was markedly lower (P < 0.01) than that of normal rats (87 ± 4.1 × 10⁶) and rats with high serum level of LDL (90 ± 6.3 × 10⁶). Similarly, the percentage of viable spermatozoa was significantly (P < 0.001) decreased from 78% to 52% by high level of OxLDL in serum. While, nonoxidised LDL did not have suppressive effects on spermatogenesis and organs weight. Consistent with these effects, the serum concentration of sex hormones including FSH (P < 0.001), LH (P < 0.001) and testosterone (P < 0.01) was significantly decreased only in rats with high level of OxLDL but not in rats with high level of nonoxidised LDL. In conclusion, high OxLDL level showed higher destructive effect on reproductive system compared to the high LDL level.     

Early conversion from cyclosporine to tacrolimus increases renal graft function in chronic allograft nephropathy at BANFF stages I and II

Switching from cyclosporine to tacrolimus without steroid pulse was suggested as a therapeutic option in chronic allograft nephropathy (CAN). Thirty‐one renal transplant recipients with CAN were prospectively converted from cyclosporine to tacrolimus (group A), in parallel 31 matched cyclosporin A (CsA) patients (group B) without CAN were followed up for 30 months. In six matching patients of groups A and B inulin and para‐aminohippurate (PAH)‐clearances and mycophenolate were measured over a span of 3 months. Transplant biopsies of group A were scored according to BANFF. While group A presented with transplant dysfunction compared with group B before switching (2.7 ± 0.16 mg/dl vs. 1.7 ± 0.09 mg/dl; P < 0.001), transplant function was equal 30 months later: it ameliorated in group A (2.0 ± 0.18 mg/dl vs. 2.7 ± 0.16 mg/dl; P < 0.001) and decreased in group B (1.9 ± 0.13 mg/dl vs. 1.7 ± 0.09 mg/dl, P < 0.05). Especially, patients with biopsy scores I and II according to BANFF benefited from tacrolimus. Within 3 months, mycophenolate acid (MPA) levels increased under tacrolimus (P < 0.05) whereas inulin and PAH‐clearances remained unchanged. At switching, antihypertensive treatment was more intense in group B, but this difference evened out. Adverse side effects were more frequent under tacrolimus. Patients with mild to moderate CAN significantly benefited from switching to tacrolimus. Increased MPA‐levels under tacrolimus might have contributed to this effect.     

Oxidative damage of erythrocyte membrane in nephrotic syndrome

 Erythrocytes are target cells for peroxidative damage. Abnormal susceptibility of erythrocyte lipids to peroxidation is believed to reflect a similar abnormality in other organs and tissues. The changes in erythrocyte lipid peroxidation [measured by malonyldialdehyde (MDA) concentration] and erythrocyte membrane cholesterol (EMC) and their correlation with plasma lipid changes were studied in 36 children with steroid-responsive minimal change nephrotic syndrome (MCNS) (16 in relapse, 20 in remission) and 30 matched healthy controls. Erythrocyte MDA levels were significantly higher in relapse [126.3±40.6 nmol/g hemoglobin (Hb)] compared with remission (101.2±21.3 nmol/g Hb, P<0.02) and in controls (95.4±20.4 nmol/g Hb, P<0.001). Plasma MDA levels in relapse were also higher than in remission (4.26±1.19 nmol/ml vs. 3.16±1.18 nmol/ml, P<0.01), and in controls (2.49±0.86 nmol/ml, P<0.001). The EMC content changed significantly during remission (1.22±0.15 mg/10¹⁰ cells in relapse, 1.09±0.19 mg/10¹⁰ cells in remission, P<0.04). These results show an increased sensitivity of red cells to lipid peroxidation in patients with steroid-sensitive nephrotic syndrome without the development of renal failure and anemia. Lipid peroxidation of plasma lipids and erythrocyte membrane may be a primary phenomenon, but this should be confirmed by investigation of peroxidation of renal lipids. Received: 7 January 1998 / Revised: 4 May 1998 / Accepted: 13 August 1998     

Abnormal cell calcium concentrations in cultured bone cells obtained from femurs of obese and noninsulin-dependent diabetic rats

Summary Cytoplasmic free calcium concentration [Ca²⁺]i was quantified in cultured bone cells with osteoblastic characteristics. The cells were obtained from femurs of obese (fa/fa) Wistar-Kyoto rats, from nonobese, noninsulin-dependent diabetic (NIDD) Sprague Dawley rats, and from their appropriate controls. [Ca²⁺]i was also determined in bone cells obtained fromin vivo insulin-treated NIDD rats. Obese (Wistar Kyoto) rats had increased body weight (313±13 vs. 249±4 g;P<0.01), decreased femur weights (0.68±0.05 vs. 0.89±0.05 g;P<0.05), similar glucose levels (148±5 vs. 139±3 mg/dl), and higher plasma insulin levels (6.0±0.5 vs. 0.7±0.1 ng/ml;P<0.01) when compared with their nonobese [(fa/+); (+/+)] littermates. Nonobese, NIDD rats, compared with their appropriate controls (nondiabetic Sprague Dawley rats) had higher plasma glucose levels (235±32 vs. 145±3 mg/dl;P<0.01) but their plasma insulins, body weights, and femur weights were similar to controls (0.7±0.1 vs 0.6±0.1 ng/ml; 302±4 vs. 318±14 g; 0.97±0.4 vs. 0.98±0.04 g, respectively). Long-term (4 weeks) daily insulin treatment (2 u/100 g) of the NIDD rats increased their plasma insulin (1.9 ng/ml;P<0.05) and body weight (369±13 g;P<0.05) but did not change their plasma glucose levels (225±5 mg/dl), or femur weights (0.98±0.4 g). [Ca²⁺]i in bone cells derived from the femurs of obese animals was higher than in cells derived from their nonobese littermates (156±22 vs. 71±13 nM;P<0.01). In bone cells from NIDD rats, [Ca²⁺]i was lower compared with controls (146±22 vs. 229±19 nM;P<0.001). Insulin treatment of the diabetic animals augmented the decrease in [Ca²⁺]i in their bone cells (68±11 nM;P<0.005 compared with nontreated rats). These data reveal that [Ca²⁺]i in cultured bone cells from obese nondiabetic and nonobese NIDD rats differs from that of their controls. Compared with their controls, the changes in [Ca²⁺]i in bone cells from the NIDD and obese animals were in opposite directions. Whether the underlying mechanisms for the changes in cell [Ca²⁺]i in nondiabetic obese and nonobese NIDD animals differ, and whether the changes in [Ca²⁺]i observed in the cultured cells reflect thein vivo condition in bone cells of these animals are questions that await further investigations.     

Changes in serum lipid levels after laparoscopic sleeve gastrectomy in morbidly obese dyslipidemic and normolipidemic patients

Background: This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity on serum lipid levels of dyslipidemic and normolipidemic patients.

Methods: 141 patients who underwent LSG between September 2014 and January 2016 were included in the study.

Results: The patients’ mean body mass index was 46.27?±?6.79?kg/m² preoperatively, 31.60?±?5.37?kg/m² in the 6th month postoperatively and 27.80?±?4.25?kg/m² in the 12th month (p?<?.001). Preoperatively and 12 months after the operation, mean total cholesterol (TC) levels and mean LDL cholesterol, mean HDL cholesterol, and mean triglyceride (TG) levels were statistically significantly decreased (p?<?.01). Comparing TC levels in the 12th month with preoperative levels, dyslipidemic patients showed a statistically more significant decrease than normolipidemic patients. LDL cholesterol levels were significantly decreased in both the groups. HDL cholesterol levels increased significantly in both groups while mean TG levels decreased significantly in patients with high preoperative TG levels, but not in patients with normal preoperative TG levels.

Conclusions: Although this technique exerts its effect primarily by reducing gastric volume, besides its metabolic and hormonal effects, it also improves serum lipid levels (decreasing TC, LDL cholesterol and TG levels, and increasing HDL cholesterol levels). It therefore contributes to decreasing cardiovascular diseases.     

Effect of deflazacort versus methylprednisone on growth, body composition, lipid profile, and bone mass after renal transplantation

Kidney function, growth velocity, weight/ height ratio, body composition, lipid profile, and bone mass were studied in a randomized, multicenter trial of deflazacort versus methylprednisone in 27 prepubertal patients with kidney transplantation. Methylprednisone (0.20±0.03) was replaced by deflazacort (13 patients, 0.30±0.03 mg/kg per day). After 12 months, creatinine clearance decreased significantly only during methylprednisone therapy. Growth velocity increased only in patients treated with deflazacort from 3.3±0.6 to 5.6±0.5 cm/year. Serum levels of several components of the insulin-like growth factor axis did not change. Weight/height ratio was increased in methylprednisone-treated patients (P<0.05) and decreased in deflazacort-treated patients (P<0.005). Lean body mass increased in both groups (P<0.005). Fat body mass and serum leptin increased only in methylprednisone-treated patients (P<0.025). Total cholesterol and low-density lipoprotein-cholesterol increased in methylprednisone-treated patients by 9.9% (P<0.05) and 12.5% (P<0.025). High-density lipoprotein-cholesterol increased by 21% (P<0.005) and apolipoprotein B decreased by 11% (P<0.005) in deflazacort-treated patients. Total skeleton and lumbar spine bone mineral density decreased in both groups, but at 1 year methylprednisone-treated patients had lost 50% more bone. Bone mineral content decreased only in methylprednisone-treated patients (P<0.01). Our data suggest that substituting deflazacort for maintenance methylprednisone might prevent height loss, excessive bone loss, and fat accumulation; and leads to an improvement in the lipoproteins of these children. Received: 13 March 1999 / Revised: 2 January 2000 / Accepted: 9 January 2000     

Relationship Between Lipids and Bone Mass in 2 Cohorts of Healthy Women and Men

A number of recent findings seem to indicate that fat and bone metabolism are strictly connected. We investigated the relationship between lipid profile and bone mineral density (BMD) in 236 either pre- or postmenopausal women, aged 35–81 years, attending our osteoporosis center (clinic group). In order to verify the consistency of the results, 265 men and 481 women aged 68–75, participating in a population-based epidemiological investigation (community cohort), were also studied. Lumbar spine, femoral neck, total hip and total body BMD, total body fat, % fat mass and lean mass were measured using dual energy X-ray absorptiometry (DXA). In the clinic group, lumbar spine and hip BMD Z score values were both strongly related to all measured serum lipids: the relationship was negative for HDL cholesterol (P < 0.05) and Apo A lipoprotein (P < 0.000) and positive for LDL cholesterol (P < 0.05), Apo B lipoprotein (P < 0.001) and triglycerides (P < 0.05). When BMD values were adjusted for body weight and BMI, most relationships remained statistically significant. In the community cohort, total body and hip BMD values were strongly related in both men and women to age, body weight, height, BMI, fat mass, lean mass, % fat mass. Total body and hip BMD were significantly related to serum lipids in both women and men. The relationship was negative for HDL cholesterol and positive for total cholesterol, triglycerides and LDL cholesterol. Most of these relationships (triglycerides, HDL cholesterol, LDL/HDL cholesterol ratio in women, and all measured lipids in men) remained statistically significant (P values ranging from 0.000 to 0.03) when the BMD values were adjusted also for anthropometric measures (body weight, height, fat mass). This study demonstrates for the first time that the lipid profile is strictly related to bone mass in both men and women. The interpretation of this association remains hypothetical but it might open new perspectives for understanding the mechanisms controlling bone metabolism.     

Serum Cholesterol by Morbidly Obese Patients after Laparoscopic Sleeve Gastrectomy and Additional Physical Activity

Background

Laparoscopic sleeve gastrectomy (LSG) has shown to be effective in serum triglycerides reduction and HDL cholesterol increase, but with little effect on total cholesterol and LDL cholesterol. Physical activity is recognized as an effective non-pharmacological intervention to reduce body fat mass and hypercholesterolemia.

Methods

A prospective observational study of all the patients undergoing LSG as bariatric technique between 2007 and 2012 was performed. All patients completed the Spanish Version of the Modifiable Physical Activity Questionnaire at two time points: baseline (pre-intervention) and 1 year after surgery, both in face-to-face interviews. Lipid profiles were monitored at the same time points.

Results

A total of 50 patients were included in the study, 44 females (88 %) and six males (12 %) with a mean age of 42.7?±?10.3 years. Comorbidities included dyslipidemia in 50 % (40 % hypercholesterolemia and 10 % hypertriglyceridemia). Preoperatively, four patients (8 %) reported moderately active physical activity and one patient (2 %) active physical exercise. The rest of the patients were sedentary. One year after surgery, 30 patients (60 %) performed any kind of active physical activity, while the rest were sedentary. Lipid profile 12 months after surgery showed significantly lower total cholesterol levels in the active group (182.8 mg/dl vs 220 mg/dl in the sedentary group; p?=?0.003). LDL cholesterol levels were also lower in the active group (103.2 vs 133 mg/dl in the sedentary group; p?=?0.015).

Conclusion

The performance of routine moderate physical activity in addition to LSG achieves a significant improvement in all parameters of the lipid profile.     

Risk factors for hyperlipidemia in long-term pediatric renal transplant recipients

Hyperlipidemia (HL) is a common problem in adult renal transplant (TP) recipients, contributing to an increased risk of cardiovascular disease and chronic TP nephropathy. There are multiple causes of HL post renal TP in adult patients, including pre TP HL, immunosuppressive agents, renal dysfunction, hypoalbuminemia secondary to nephrotic syndrome, obesity, and conditions that lead to end-stage renal disease (ESRD). We evaluated the incidence and risk factors of HL in 62 pediatric renal TP recipients (15.4±4.2 years, range-3.0–22.3 years) with long-term (6.7±3.1 years) functioning [glomerular filtration rate (GFR) 66.7±23.2 ml/min per 1.73 m²] allografts. The mean serum cholesterol (C) level was 205.5±43.6 mg/dl. Thirty-two patients (51.6%) exhibited elevated serum C levels. The mean serum triglyceride (TG) level was 157.3±88.4 mg/dl. Serum TG levels were elevated in 32 patients (51.6%). In patients with elevated serum levels of either C or TG, the mean low-density lipoprotein level (LDL) was 138.6±44.1 mg/dl (normal <130 mg/dl) and the high-density lipoprotein (HDL) level 54.6±15.9 mg/dl (normal>34 mg/dl). Of those patients studied, 45.5% had high LDL levels, whereas 9.1% exhibited low HDL levels. The two risk factors for elevated serum C levels in our patient population were pre-TP HL and increased years since TP. The only risk factor for elevated serum TG levels was reduced GFR. A family history of HL had a significant deleterious impact upon serum levels of C (P=0.01), but did not affect serum TG levels (P=0.7). Years on dialysis prior to TP, history of prior TP, gender, body mass index, and disease leading to ESRD had no influence upon the development of post-TP HL. We conclude that post-renal TP HL is a significant problem in pediatric renal TP recipients. Received: 13 January 1999 / Revised: 19 May 1999 / Accepted: 21 May 1999     

Clinical evaluation of rosuvastatin in heart transplant patients with hypercholesterolemia and therapeutic failure of other statin regimens: short‐term and long‐term efficacy and safety results

We conducted an observational study of 30 heart transplant recipients with serum low‐density lipoprotein cholesterol (LDL‐c) >100 mg/dl despite previous statin therapy, who were treated with rosuvastatin 10 mg daily (5 mg in case of renal dysfunction). Serum lipids, creatine phosphokinase (CPK), bilirubin, and hepatic enzymes were prospectively measured 2, 4, and 12 weeks after the initiation of the drug. Clinical outcomes of patients who continued on long‐term rosuvastatin therapy beyond this 12‐week period were reviewed in February 2015. Over the 12‐week period following rosuvastatin initiation, serum levels of total cholesterol (TC) and LDL‐c and the ratio TC/high‐density lipoprotein cholesterol (HDL‐c) decreased steadily (P < 0.001). Average absolute reductions of these three parameters were –48.7 mg/dl, –46.6 mg/dl, and –0.9, respectively. Seventeen (57%) achieved a serum LDL‐c < 100 mg/dl. No significant changes from baseline were observed in serum levels of triglycerides, HDL‐c, hepatic enzymes, bilirubin, or CPK. Twenty‐seven (90%) patients continued on long‐term therapy with rosuvastatin over a median period of 3.6 years, with no further significant variation in lipid profile. The drug was suspended due to liver toxicity in 1 (3.3%) patient and due to muscle toxicity in 2 (6.7%) patients. All adverse reactions resolved rapidly after rosuvastatin withdrawal. Our study supports rosuvastatin as a reasonable alternative for heart transplant recipients with hypercholesterolemia and therapeutic failure of other statin regimens.     

Does Laparoscopic Gastric Bypass Result in a Healthier Body Composition? An Affirmative Answer

Background: Bariatric surgery results in sustained weight loss. While weight loss is the goal of bariatric surgery, fat loss and muscle conservation are germaine goals. This study investigated the hypothesis that body composition would significantly change after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: Patients undergoing LRYGBP were studied. Percent fat and percent water were calculated via bioelectrical impedance analysis (BIA). Waist and hip circumference were measured in all patients as well. Measurements were taken preoperatively, and at 1 month, 3 months, 6 months, and 1 year. Non-parametric ANOVA was utilized for statistical analysis. Results: There were 151 patients included in this study. Fat percentage (48.6 ± 10.0 vs 34.6 ± 10.8; P<0.001), total fat mass (141 ± 37 vs 67 ± 30; P<0.0001) and total water mass (108 ± 27 vs 93 ± 23; P<0.0001) decreased postoperatively at 1 year. Water percentage increased postoperatively at 1 year (37.0 ± 6.6 vs 52.5 ± 3.3; P<0.001). Waist:hip ratio improved from preoperatively to 1 year postoperatively (0.895 ± 0.115 vs 0.811 ± 0.076; P<0.001). Conclusions: Bariatric surgery results not only in fat loss but also in a change in body composition. Improved waist:hip ratio, fat percentage decreases, and water percentage increases all indicate an overall healthy body composition. While weight loss is important, improvement in body composition should be another recognized benefit of bariatric surgery.